1983, 04-22 Permit: 83A-3173 AdditionPLAN NUMBER
APPLICATION /PERMIT
SPOKANE COUNTY - DEPARTMENT OF BUILDING & SAFETY
NORTH 811 JEFFERSON / SPOKANE, WASHINGTON 99260 / (509) 456 -3675
APPLICANT: COMPLETE NUMBERED SPACES - PRESS HARD TO MAKE 3 COPIES
STREET ADDRESS
1. %L --64a1.3 (vs v..)
PARCEL NO.
14s4 -2- 24R
LOT
2. h
BLOCK
SUBDIVISION
7" To 1.k.A., t, .. -{-hr, -
Ary
OWNER
3 . -4o14ty
MAILING ADDRESS
PHONE
PHONE
LEGAL DESCRIPTION:
(-J
ZIP
Actual Set Backs in Feet to:
North l South M' I East
4.
5.
CONTRACTOR
LICENSE EXPIRES
PHONE
Size of Parcel
6X tom°
IWest 4„31 4—
Residentially
Commercial ❑
Zone Classification
ADDRESS
sA
DESIGNER
ZIP
Type Const.
Occupancy
i2 -51ryt -+
Sprinklered
❑Yes ❑No ❑Req'd.
PHONE
New Const. Valuation
dV9',7l%7
Remodeled Valuation
Total Bldg. Floor Area
(c'1
ADDRESS
ZIP
Main Floor
Upper Floors
Garage /Storage
Greenhouse
CHANGE OF USE FROM
6.
TO
Cover Deck
Uncv. Deck
Fin. Basement
Unfin. Basement
TYPE ❑ EW ❑ ALT. F AD'N. ❑ RPL. ❑ MVE.
7. OF
WORK 11/BLD. ❑ PLMB. El MECH. DI M.H. ❑ POOL
❑ OTHER
No. Baths
No. Floors
Certifi. of Exempt.
or Variance
8.
DESCRIBE WORK
ACID i -rt
Shorelines /Flood Hazard
Yes NotApplic. ❑
No. Fin. Rooms
Required Yes No
No. Dwellings
Number
Received Yes❑ No❑
Plans Required fe"..../
Received ❑
9.
VALUATION SOOURCE
UTILITIES
GAS ELECTRIC
WATER SEWAGE -
PUBLIC ❑ SEPTIC Tt3
PRIVATE ❑ SEWER ❑
Ownership
Public ❑ Private V
I hereby certify that I have read and examined this application and have read the "NOTICE" provisions included on
reverse side, and know the same to be true and correct. All provisions of laws and ordinances governing this type of
work will be complied with whether specified herein or not. The granting of a permit does not presume to give au-
thority to violate or cancel • . • rovisions of any o her state or local law regulating construction or the performance
of construction. SEE REV RSE SIDE FOR REQ RED INSPECTIONS /
SIGNATURE OF
OWNER OR AGE
SPECIAL APPROV
PRELIM. FINA
APPLICAT91
DATE l
-zo -83
SPECIAL CONDITIONS: (SEE REVERSE SIDE FOR NOTICE)
Env. Health
Planning
Fire
Prevent.
Engineer
Utilities
SEPA
Plans
Exam.
Building
Tech.
1
PERMIT IS NONTRANSFERABLE
PERMIT IS NULL AND VOID IF WORK HAS NOT COMMENCED
IN 180 DAYS
FEES COLLECTED
Building
Plumbing
Mech.
Plan Check
SEPA
Modular/
MFG. Home
Other (Specify)
TOTAL $
PERMIT(JUMB
*8200
*82.006
/ *0,00
317,22
04 -22 -83
2 6479,
WHEN MACHINE VALIDATED IN THIS SPACE,
THIS BECOMES A PERMIT.
04 -22 -83 317,35 *82.002
DATE ISSUED PERMIT NO. TOTAL
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2
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